2Department of Mathematics, University of Manitoba, Winnipeg, Manitoba, Canada

3Public Health Agency of Canada, Ottawa, Ontario, Canada

4Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

Correspondence to Dr Seyed M Moghadas; moghadas{at}yorku.ca

Received 7 June 2012

Accepted 27 July 2012

Published 1 September 2012

Abstract

Objectives During the first wave of the 2009 influenza pH1N1, disease burden was distributed in a geographically heterogeneous fashion.
It was particularly high in some remote and isolated Canadian communities when compared with urban centres. We sought to estimate
the transmissibility (the basic reproduction number) of pH1N1 strain in some remote and isolated Canadian communities.

Design A discrete time susceptible-exposed-infected transmission model was fit to infection curves simulated from laboratory-confirmed
case counts for pH1N1 on each day. The sampling from Poisson distribution was used to estimate the basic reproduction number,
R0, of pH1N1 during the spring wave for five different communities in Manitoba and Nunavut, Canada, where remote and isolated
communities experienced a high incidence of infection, and high rates of hospitalisation and intensive care unit admission.

Setting Remote and isolated communities in Northern Manitoba, Nunavut, and the largest urban centre (Winnipeg) in the province of
Manitoba, Canada.

Results Using published values of the exposed and infectious periods specific to H1N1 infection, corresponding to the average generation
time of 2.78 days, we estimated a mean value of 2.26 for R0 (95% CI 1.57 to 3.75) in a community located in northern Manitoba. Estimates of R0 for other communities in Nunavut varied considerably with higher mean values of 3.91 (95% CI 3.08 to 4.87); 2.03 (95% CI
1.50 to 3.19); and 2.45 (95% CI 1.68 to 3.44). We estimated a lower mean value of 1.57 (95% CI 1.35 to 1.87) for R0 in the Winnipeg health region, as the largest urban centre in Manitoba.

Conclusions Influenza pH1N1 appears to have been far more transmissible in rural and isolated Canadian communities than other large urban
areas. The differential severity of the pandemic in these regions may be explained partly by differential transmissibility,
and suggests the need for more nuanced, targeted or population-specific control strategies in Canada.